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01-10-2008 | Review

Modic changes: a systematic review of the literature

Authors: Yue-Hui Zhang, Chang-Qing Zhao, Lei-Sheng Jiang, Xiao-Dong Chen, Li-Yang Dai

Published in: European Spine Journal | Issue 10/2008

Abstract

Modic changes (MC) are a common phenomenon on magnetic resonance imaging (MRI) in spinal degenerative diseases and strongly linked with low back pain (LBP). Histology, radiology, potential mechanisms, natural history and clinical studies of MC has formed the foundation on which our understanding of spinal degenerative diseases is built. The objective of this study was to provide a review of recent important advances in the study of MC and their clinical significance. This review article summarizes these studies, by delineating the possible mechanisms, and raising doubts and new questions. The related aspects such as discography and differential diagnosis with spinal infection and tumor on MRI are also discussed. Although most of researchers believe that MC are common findings in patients with spinal degenerative diseases and have an association with discogenic LBP, different results between studies may be produced from the differences in study design, inclusion criteria, and sample size. How the present knowledge of MC affects the management of spinal degenerative diseases remains unclear. Further studies of MC will explore therapeutic possibilities for future treatments of spinal degenerative diseases.

Adams MA (2004) Biomechanics of back pain. Acupunct Med 22:178–188PubMedCrossRef

Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P (2000) Mechanical initiation of intervertebral disc degeneration. Spine 25:1625–1636. doi:10.1097/00007632-200007010-00005 PubMedCrossRef

Adams MA, McNally DS, Dolan P (1996) ‘Stress’ distributions inside intervertebral discs: the effects of age and degeneration. J Bone Joint Surg Br 78:965–972. doi:10.1302/0301-620X78B6.1287 PubMedCrossRef

Albert HB, Kjaer P, Jensen TS, Sorensen JS, Bendix T, Manniche C (2008) Modic changes: possible causes and relation to low back pain. Med Hypotheses 70:361–368. doi:10.1016/j.mehy.2007.05.014 PubMedCrossRef

Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982. doi:10.1007/s00586-007-0336-8 PubMedCrossRef

Barth M, Diepers M, Weiss C, Thome C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy. part 2: radiographic evaluation and correlation with clinical outcome. Spine 33:273–279PubMed

Beaman DN, Graziano GP, Glover RA, Wojtys EM, Chang V (1993) Substance P innervation of lumbar spine facet joints. Spine 18:1044–1049. doi:10.1097/00007632-199306150-00014 PubMedCrossRef

Besalti O, Pekcan Z, Sirin YS, Erbas G (2006) Magnetic resonance imaging findings in dogs with thoracolumbar intervertebral disk disease: 69 cases (1997–2005). J Am Vet Med Assoc 228:902–908. doi:10.2460/javma.228.6.902 PubMedCrossRef

Boden SD, Davis DO, Dina TS, Sunner JL, Wiesel SW (1992) Postoperative diskitis: distinguishing early MR imaging findings from normal postoperative disk space changes. Radiology 184:765–771PubMed

10.

Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA (1998) Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J 7:363–368. doi:10.1007/s005860050091 PubMedCrossRef

11.

Burke JG, Watson RW, McCormack D, Dowling FE, Walsh MG, Fitzpatrick JM (2002) Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br 84:196–201. doi:10.1302/0301-620X.84B2.12511 PubMedCrossRef

12.

Buttermann GR (2004) The effect of spinal steroid injections for degenerative disc disease. Spine J 4:495–505. doi:10.1016/j.spinee.2004.03.024 PubMedCrossRef

13.

Buttermann GR, Heithoff KB, Ogilvie JW, Transfeldt EE, Cohen M (1997) Vertebral body MRI related to lumbar fusion results. Eur Spine J 6:115–120. doi:10.1007/BF01358743 PubMedCrossRef

14.

Carragee EJ, Alamin TF, Miller JL, Carragee JM (2005) Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 5:24–35. doi:10.1016/j.spinee.2004.05.250 PubMedCrossRef

15.

Cavanaugh JM, Ozaktay AC, Yamashita T, Avramov A, Getchell TV, King AI (1997) Mechanisms of low back pain: a neurophysiologic and neuroanatomic study. Clin Orthop Relat Res 166–180

16.

Chung CB, Vande Berg BC, Tavernier T, Cotten A, Laredo JD, Vallee C et al (2004) End plate marrow changes in the asymptomatic lumbosacral spine: frequency, distribution and correlation with age and degenerative changes. Skeletal Radiol 33:399–404. doi:10.1007/s00256-004-0780-z PubMedCrossRef

17.

Crock HV (1970) A reappraisal of intervertebral disc lesions. Med J Aust 1:983–989PubMed

18.

Crock HV (1986) Internal disc disruption: a challenge to disc prolapse fifty years on. Spine 11:650–653. doi:10.1097/00007632-198607000-00028 PubMedCrossRef

19.

de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149:531–534PubMed

20.

Fayad F, Lefevre-Colau MM, Rannou F, Quintero N, Nys A, Mace Y et al (2007) Relation of inflammatory modic changes to intradiscal steroid injection outcome in chronic low back pain. Eur Spine J 16:925–931. doi:10.1007/s00586-006-0301-y PubMedCrossRef

21.

Girard CJ, Schweitzer ME, Morrison WB, Parellada JA, Carrino JA (2004) Thoracic spine disc-related abnormalities: longitudinal MR imaging assessment. Skeletal Radiol 33:216–222. doi:10.1007/s00256-003-0736-8 PubMedCrossRef

22.

Gruber HE, Hanley EN Jr (2003) Recent advances in disc cell biology. Spine 28:186–193. doi:10.1097/00007632-200301150-00017 PubMedCrossRef

23.

Hansson T, Roos B (1981) Microcalluses of the trabeculae in lumbar vertebrae and their relation to the bone mineral content. Spine 6:375–380. doi:10.1097/00007632-198107000-00008 PubMedCrossRef

24.

Hoenen-Clavert V, Rat AC, Loeuille D, Bettembourg-Brault I, Michel-Batot C, Blum A et al (2007) Inflammatory and structural evaluation in spondyloarthritis: magnetic resonance imaging analysis of axial and peripheral involvement. J Rheumatol 34:762–768PubMed

25.

Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA (2005) Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine 30:1541–1549. doi:10.1097/01.brs.0000167536.60002.87 PubMedCrossRef

26.

Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral endplate signal (Modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 48:748–754. doi:10.1080/02841850701422112 PubMedCrossRef

27.

Jones A, Clarke A, Freeman BJ, Lam KS, Grevitt MP (2005) The Modic classification: inter- and intraobserver error in clinical practice. Spine 30:1867–1869. doi:10.1097/01.brs.0000173898.47585.7d PubMedCrossRef

28.

Karchevsky M, Schweitzer ME, Carrino JA, Zoga A, Montgomery D, Parker L (2005) Reactive endplate marrow changes: a systematic morphologic and epidemiologic evaluation. Skeletal Radiol 34:125–129. doi:10.1007/s00256-004-0886-3 PubMedCrossRef

29.

Kim JM, Lee SH, Ahn Y, Yoon DH, Lee CD, Lim ST (2007) Recurrence after successful percutaneous endoscopic lumbar discectomy. Minim Invasive Neurosurg 50:82–85. doi:10.1055/s-2007-982504 PubMedCrossRef

30.

Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C (2006) Modic changes and their associations with clinical findings. Eur Spine J 15:1312–1319. doi:10.1007/s00586-006-0185-x PubMedCrossRef

31.

Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180. doi:10.1097/01.brs.0000162396.97739.76 PubMedCrossRef

32.

Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T (2005) An epidemiologic study of MRI and low back pain in 13-year-old children. Spine 30:798–806. doi:10.1097/01.brs.0000157424.72598.ec PubMedCrossRef

33.

Kleinstuck F, Dvorak J, Mannion AF (2006) Are “structural abnormalities” on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine 31:2250–2257. doi:10.1097/01.brs.0000232802.95773.89 PubMedCrossRef

34.

Kokkonen SM, Kurunlahti M, Tervonen O, Ilkko E, Vanharanta H (2002) Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography diskography. Spine 27:2274–2278. doi:10.1097/00007632-200210150-00017 PubMedCrossRef

35.

Korhonen T, Karppinen J, Paimela L, Malmivaara A, Lindgren KA, Bowman C et al (2006) The treatment of disc-herniation-induced sciatica with infliximab: one-year follow-up results of FIRST II, a randomized controlled trial. Spine 31:2759–2766. doi:10.1097/01.brs.0000245873.23876.1e PubMedCrossRef

36.

Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M, Haapea M, Vanharanta H et al (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine 31:1714–1718. doi:10.1097/01.brs.0000224167.18483.14 PubMedCrossRef

37.

Kuisma M, Karppinen J, Niinimaki J, Ojala R, Haapea M, Heliovaara M et al (2007) Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine 32:1116–1122. doi:10.1097/01.brs.0000261561.12944.ff PubMedCrossRef

38.

Lang P, Chafetz N, Genant HK, Morris JM (1990) Lumbar spinal fusion. Assessment of functional stability with magnetic resonance imaging. Spine 15:581–588. doi:10.1097/00007632-199006000-00028 PubMedCrossRef

39.

Leboeuf-Yde C, Kjaer P, Bendix T, Manniche C (2008) Self-reported hard physical work combined with heavy smoking or overweight may result in so-called Modic changes. BMC Musculoskelet Disord 9:5. doi:10.1186/1471-2474-9-5 PubMedCrossRef

40.

Marshman LA, Trewhella M, Friesem T, Bhatia CK, Krishna M (2007) Reverse transformation of Modic type 2 changes to Modic type 1 changes during sustained chronic low-back pain severity Report of two cases and review of the literature. J Neurosurg Spine 6:152–155. doi:10.3171/spi.2007.6.2.152 PubMedCrossRef

41.

Masaryk TJ, Boumphrey F, Modic MT, Tamborrello C, Ross JS, Brown MD (1986) Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr 10:917–923PubMedCrossRef

42.

Miller G (1990) The spine. In: Berquist T (ed) MRI of the musculoskeletal system, 2nd edn. Raven, New York

43.

Mitra D, Cassar-Pullicino VN, McCall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:1574–1581. doi:10.1007/s00330-004-2314-4 PubMedCrossRef

44.

Modic MT (2007) Modic type 1 and type 2 changes. J Neurosurg Spine 6:150–151. doi:10.3171/spi.2007.6.2.150 PubMedCrossRef

45.

Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM et al (1985) Vertebral osteomyelitis: assessment using MR. Radiology 157:157–166PubMed

46.

Modic MT, Masaryk TJ, Ross JS, Carter JR (1988) Imaging of degenerative disk disease. Radiology 168:177–186PubMed

47.

Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199PubMed

48.

Narvani AA, Tsiridis E, Wilson LF (2003) High-intensity zone, intradiscal electrothermal therapy, and magnetic resonance imaging. J Spinal Disord Tech 16:130–136PubMed

49.

Ohtori S, Inoue G, Ito T, Koshi T, Ozawa T, Doya H et al (2006) Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back pain and Modic Type 1 or Type 2 changes on MRI. Spine 31:1026–1031. doi:10.1097/01.brs.0000215027.87102.7c PubMedCrossRef

50.

Peterson CK, Gatterman B, Carter JC, Humphreys BK, Weibel A (2007) Inter- and intraexaminer reliability in identifying and classifying degenerative marrow (Modic) changes on lumbar spine magnetic resonance scans. J Manipulative Physiol Ther 30:85–90. doi:10.1016/j.jmpt.2006.12.001 PubMedCrossRef

51.

Peterson CK, Humphreys BK, Pringle TC (2007) Prevalence of Modic degenerative marrow changes in the cervical spine. J Manipulative Physiol Ther 30:5–10. doi:10.1016/j.jmpt.2006.11.013 PubMedCrossRef

52.

Putzier M, Schneider SV, Funk JF, Tohtz SW, Perka C (2005) The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine 30:E109–E114. doi:10.1097/01.brs.0000154630.79887.ef PubMedCrossRef

53.

Rannou F, Ouanes W, Boutron I, Lovisi B, Fayad F, Mace Y et al (2007) High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes. Arthritis Rheum 57:1311–1315. doi:10.1002/art.22985 PubMedCrossRef

54.

Resnick D, Niwayama G (1978) Intervertebral disc abnormalities associated with vertebral metastasis: observations in patients and cadavers with prostatic cancer. Invest Radiol 13:182–190. doi:10.1097/00004424-197805000-00002 PubMedCrossRef

55.

Saifuddin A, Renton P, Taylor BA (1998) Effects on the vertebral end-plate of uncomplicated lumbar discography: an MRI study. Eur Spine J 7:36–39. doi:10.1007/s005860050024 PubMedCrossRef

56.

Sandhu HS, Sanchez-Caso LP, Parvataneni HK, Cammisa FP Jr, Girardi FP, Ghelman B (2000) Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI. J Spinal Disord 13:438–443. doi:10.1097/00002517-200010000-00012 PubMedCrossRef

57.

Schenk P, Laubli T, Hodler J, Klipstein A (2006) Magnetic resonance imaging of the lumbar spine: findings in female subjects from administrative and nursing professions. Spine 31:2701–2706. doi:10.1097/01.brs.0000244570.36954.17 PubMedCrossRef

58.

Schmid G, Witteler A, Willburger R, Kuhnen C, Jergas M, Koester O (2004) Lumbar disk herniation: correlation of histologic findings with marrow signal intensity changes in vertebral endplates at MR imaging. Radiology 231:352–358. doi:10.1148/radiol.2312021708 PubMedCrossRef

59.

Shen M, Razi A, Lurie JD, Hanscom B, Weinstein J (2007) Retrolisthesis and lumbar disc herniation: a preoperative assessment of patient function. Spine J 7:406–413. doi:10.1016/j.spinee.2006.08.011 PubMedCrossRef

60.

Toyone T, Takahashi K, Kitahara H, Yamagata M, Murakami M, Moriya H (1994) Vertebral bone-marrow changes in degenerative lumbar disc disease: an MRI study of 74 patients with low back pain. J Bone Joint Surg Br 76:757–764PubMed

61.

Ulmer JL, Elster AD, Mathews VP, Allen AM (1995) Lumbar spondylolysis: reactive marrow changes seen in adjacent pedicles on MR images. AJR Am J Roentgenol 164:429–433PubMed

62.

Vital JM, Gille O, Pointillart V, Pedram M, Bacon P, Razanabola F et al (2003) Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 28:715–721. doi:10.1097/00007632-200304010-00017 PubMedCrossRef

63.

Waddell G (1987) 1987 Volvo award in clinical sciences: a new clinical model for the treatment of low-back pain. Spine 12:632–644. doi:10.1097/00007632-198709000-00002 PubMedCrossRef

64.

Weishaupt D, Zanetti M, Hodler J, Boos N (1998) MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209:661–666PubMed

65.

Weishaupt D, Zanetti M, Hodler J, Min K, Fuchs B, Pfirrmann CW et al (2001) Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology 218:420–427PubMed

66.

Williams FM, Manek NJ, Sambrook PN, Spector TD, Macgregor AJ (2007) Schmorl’s nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Rheum 57:855–860. doi:10.1002/art.22789 PubMedCrossRef

Title: Modic changes: a systematic review of the literature
Authors: Yue-Hui Zhang
Chang-Qing Zhao
Lei-Sheng Jiang
Xiao-Dong Chen
Li-Yang Dai
Publication date: 01-10-2008
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 10/2008
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-008-0758-y

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Modic changes: a systematic review of the literature

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